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1 Internal Medicine, University Of Missouri-Columbia School of Medicine, Columbia, Missouri, United States
2 Internal Medicine, Division of Nephrology, University of Missouri-Columbia School of Medicine, Columbia, Missouri, United States
* To whom correspondence should be addressed. E-mail: sowerj{at}health.missouri.edu.
Hypertension commonly occurs in conjunction with insulin resistance and other components of the cardiometabolic syndrome. Insulin resistance plays a significant role in the relationship between hypertension, type 2 diabetes mellitus, chronic kidney disease and cardiovascular disease. There is accumulating evidence that insulin resistance occurs in cardiovascular and renal tissue, as well as in classical metabolic tissues (i.e. skeletal muscle, liver and adipose tissue). Activation of the renin-angiotensin-aldosterone system and subsequent elevations in angiotensin II and aldosterone, as seen in the cardiometabolic syndrome contribute to altered insulin/IGF-1 signaling pathways and reactive oxygen species formation to induce endothelial dysfunction and cardiovascular disease. This review will examine currently understood mechanisms underlying the development of resistance to the metabolic actions of insulin in cardiovascular, as well as skeletal muscle tissue.
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